Shortening of the twitch stabilization period by tetanic stimulation in acceleromyography in infants, children and young
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ORIGINAL RESEARCH
Shortening of the twitch stabilization period by tetanic stimulation in acceleromyography in infants, children and young adults (STSTS‑Study): a prospective randomised, controlled trial Christoph Unterbuchner1 · Markus Werkmann1 · Raphael Ziegleder1 · Stephanie Kraus1 · Timo Seyfried1 · Bernhard Graf1 · Florian Zeman2 · Manfred Blobner3 · Barbara Sinner1 · Thomas Metterlein1 Received: 12 June 2019 / Accepted: 26 November 2019 © Springer Nature B.V. 2019
Abstract Acceleromyography is characterised by an increase of the twitch response T1 (first twitch of the train-of-four [TOF]) during first 30 min of monitoring known as the staircase phenomenon. In adults the staircase phenomenon can be avoided by tetanic prestimulation. This study examined, if tetanic prestimulation eliminates the staircase phenomenon in children. After written informed consent, the neuromuscular function of 80 children, 10 in each age group ( 7%
Analysed n = 10 • Excluded n = 2 T1-T1 var. > 7%
not found (device failure). Posthoc exclusions were necessary if the difference between two consecutive T1 values was > 7%
13
Journal of Clinical Monitoring and Computing
3 Results
4 Discussion
In 104 of 142 recruited patients neuromuscular measurement was performed. Finally 80 participants were enrolled and evaluated (Fig. 1), whose baseline characteristics are presented in Table 1. Technical difficulties such as inability to find a supramaximal stimulation current or difficulties to fix the devices within the time frame of 60 s between tetanus and TOF stimulation more frequently appeared in the youngest age groups. Minor local skin irritation and redness at the stimulation site developed in 18 patients independently of tetanic stimulation and age. Induction of anesthesia with sevoflurane by facemask was performed in 17 patients preferrently in the younger children (Table 1). No patient needed a manual adjustment of the gain factor of the TOF Watch SX®. Tetanic prestimulation significantly affected the T1 values avoiding the staircase phenomenon (upper panel of Fig. 2, p
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